Individual
ALEXIS PENDERGRASS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3838 NW 36TH ST STE 200, OKLAHOMA CITY, OK 73112-2916
(405) 702-9032
Mailing address
7123 NW 46TH ST, BETHANY, OK 73008-2315
(405) 702-9032
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
10/11/2022
Last updated
10/11/2022
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